Healthcare provider bill validation

Abstract

A system for validation of healthcare provider bills includes obtaining an image of the bill on a mobile device which uses optical character recognition to resolve the patient identity, provider identity and amount due as alphanumeric characters. The system also receives adjudicated claims data from insurance companies in a non-standardized format. A claims conversion server converts the adjudicated claims data to a standardized machine-readable format. The standardized adjudicated claims data and provider bill are validated against each other in real-time so the patient can make payment in an accurate amount without having to first receive and decipher an EOB form.

What is claimed is: 
     
       1. A method of standardizing healthcare records to analyze the validity of a healthcare provider's unpaid bill, comprising:
 providing remote access to insurance providers over a first network so any one of the insurance providers can provide adjudicated claims data to a claims conversion server, wherein the one of the insurance providers provides the adjudicated claims data in a non-standardized format; 
 converting, by a claims conversion server, the non-standardized adjudicated claims data into a standardized format; 
 storing the standardized adjudicated claims data in an EOB database in the standardized format; 
 providing remote access to users over a second network so any one of the users can upload the healthcare provider's unpaid bill through a graphic user interface on a mobile device; 
 automatically identifying the one user's identity; 
 initiating a bill validation module, wherein the bill validation module executes the following steps: 
 automatically identifying from the healthcare provider's unpaid bill one or more of the following: a healthcare provider's identity, an amount due, and a service date; 
 automatically accessing the EOB database and performing a scoring algorithm to determine if any of the standardized adjudicated claims data in the EOB database contains enough similarities to the one user's identity, the healthcare provider's identity, the amount due, or the service date to exceed a predetermined scoring threshold; 
 responsive to one of the standardized adjudicated claims data exceeding the predetermined scoring threshold, automatically generating a message containing a confirmation that the healthcare provider's unpaid bill has been validated; and 
 transmitting the message to the one user over the second network, so that the one user has immediate access to up-to-date payment information. 
 
     
     
       2. The method of  claim 1 , wherein the one user's identity is identified by one or more of a name, a user login, a social security number, a date of birth, or a zip code. 
     
     
       3. The method of  claim 1 , further including receiving the healthcare provider's unpaid bill as a first digital image taken with a digital camera and converting the first digital image to a digital dataset of alphanumeric characters, wherein the digital dataset includes the healthcare provider's identity, the amount due, and the service date. 
     
     
       4. The method of  claim 1 , further comprising displaying on the one user's mobile device a comparison of the amount of the healthcare provider's unpaid bill that the one user is required to pay as calculated by the healthcare provider and the amount of the healthcare provider's unpaid bill that the one user is required to pay as reported by standardized adjudicated claims data. 
     
     
       5. The method of  claim 4 , further comprising displaying a selectable control to pick whether to pay the amount of the healthcare provider's unpaid bill as calculated by the healthcare provider or the amount of the healthcare provider's unpaid bill that the one user is required to pay as reported by standardized adjudicated claims data. 
     
     
       6. The method of  claim 1 , further comprising:
 responsive to none of the standardized adjudicated claims data exceeding the predetermined scoring threshold, automatically generating a message containing an explanation that the healthcare provider's unpaid bill has not been validated by the standardized adjudicated claims data; and 
 transmitting the message to the one user over the second network, so that the one user has immediate access to up-to-date payment information. 
 
     
     
       7. A method of standardizing healthcare records to analyze the validity of a healthcare provider's unpaid bill, comprising:
 providing remote access to insurance providers over a first network so any one of the insurance providers can provide adjudicated claims data to a claims conversion server, wherein the one of the insurance providers provides the adjudicated claims data in a non-standardized format; 
 converting, by a claims conversion server, the non-standardized adjudicated claims data into a standardized format; 
 storing the standardized adjudicated claims data in an EOB database in the standardized format; 
 receiving a first digital image taken with a digital camera and digitally sent from a patient's mobile device, the first digital image comprising the healthcare provider's unpaid bill for a patient; 
 converting the first digital image to a digital dataset of alphanumeric characters, wherein the digital dataset includes a healthcare provider's identity, an amount due, and a service date; 
 identifying a patient's identity; 
 initiating a bill validation module, wherein the bill validation module executes the following steps: 
 automatically accessing the EOB database and retrieving standardized adjudicated claims data in the EOB database that corresponds to the patient's identity; 
 automatically matching the digital dataset of the healthcare provider's unpaid bill to a claim in the retrieved standardized adjudicated claims data that corresponds to the patient's identity; 
 automatically validating the amount due listed on the healthcare provider's unpaid bill by comparing the amount due listed on the healthcare provider's unpaid bill against an amount that the patient must pay out-of-pocket provided in the matched claim; 
 responsive to validating the amount due listed on the healthcare provider's unpaid bill, automatically generating a message containing a confirmation that the healthcare provider's unpaid bill has been validated; 
 transmitting the message to the patient, so that the patient has immediate access to up-to-date payment information; and 
 providing, on the graphic user interface, the patient with an option to initiate a digital payment to the healthcare provider. 
 
     
     
       8. The method of  claim 7 , wherein the bill validation module further includes:
 automatically identifying from the healthcare provider's unpaid bill a healthcare provider's identity, an amount due, and a service date; 
 performing a scoring algorithm when validating the amount due listed on the healthcare provider's unpaid bill, wherein the scoring algorithm calculates whether any of the standardized adjudicated claims data in the EOB database contains enough similarities to the healthcare provider's identity, the amount due, and the service date to exceed a predetermined scoring threshold to validate the amount due listed on the healthcare provider's unpaid bill; 
 wherein the step of automatically generating a message containing a confirmation that the healthcare provider's bill has been validated occurs when one of the standardized adjudicated claims data exceeds the predetermined scoring threshold. 
 
     
     
       9. The method of  claim 7 , wherein the patient's identity is identified by one or more of a name, user login information, a social security number, a date of birth, or a zip code. 
     
     
       10. The method of  claim 7 , further comprising displaying on the patient's mobile device a comparison of the amount of the healthcare provider's unpaid bill that the patient is required to pay as calculated by the healthcare provider and the amount of the healthcare provider's unpaid bill that the patient is required to pay as reported by the standardized adjudicated claims data. 
     
     
       11. The method of  claim 10 , further comprising displaying a selectable control to pick whether to pay the amount of the healthcare provider's unpaid bill as calculated by the healthcare provider or the amount of the healthcare provider's unpaid bill that the patient is required to pay as reported by standardized adjudicated claims data. 
     
     
       12. The method of  claim 7 , further comprising:
 responsive to none of the standardized adjudicated claims data matching the digital dataset, automatically generating a message containing an explanation that the healthcare provider's unpaid bill has not been validated by the standardized adjudicated claims data; and 
 transmitting the message to the patient, so that the patient has immediate access to up-to-date payment information. 
 
     
     
       13. A method of standardizing healthcare records to analyze the validity of a healthcare provider's unpaid bill, comprising:
 providing remote access to insurance providers over a first network so any one of the insurance providers can provide adjudicated claims data to a claims conversion server, wherein the one of the insurance providers provides the adjudicated claims data in a non-standardized format; 
 converting, by a claims conversion server, the non-standardized adjudicated claims data into a standardized format; 
 receiving a first digital image taken with a digital camera and digitally sent from a patient's mobile device, the first digital image comprising the healthcare provider's unpaid bill for a patient; 
 converting the first digital image to a digital dataset of alphanumeric characters, wherein the digital dataset includes a healthcare provider's identity, an amount due, and a service date; 
 identifying a patient's identity; 
 initiating a bill validation module, wherein the bill validation module executes the following steps:
 automatically identifying standardized adjudicated claims data that corresponds to the patient's identity; 
 automatically matching the digital dataset of the healthcare provider's unpaid bill to a claim in the retrieved standardized adjudicated claims data that corresponds to the patient's identity; 
 automatically validating the amount due listed on the healthcare provider's unpaid bill by comparing the amount due listed on the healthcare provider's unpaid bill against an amount that the patient must pay out-of-pocket provided in the matched claim; 
 responsive to validating the amount due listed on the healthcare provider's unpaid bill, automatically generating a message containing a confirmation that the healthcare provider's unpaid bill has been validated; and 
 transmitting the message to the patient, so that the patient has immediate access to up-to-date payment information. 
 
 
     
     
       14. The method of  claim 13 , further including providing, on a graphic user interface, the patient with an option to initiate a digital payment to the healthcare provider. 
     
     
       15. The method of  claim 13 , further including storing the standardized adjudicated claims data in an EOB database in the standardized format. 
     
     
       16. The method of  claim 13 , wherein the bill validation module further includes:
 performing a scoring algorithm when validating the amount due listed on the healthcare provider's unpaid bill, wherein the scoring algorithm calculates whether any of the standardized adjudicated claims data in the EOB database contains enough similarities to the healthcare provider's identity, the amount due, and the service date to exceed a predetermined scoring threshold to validate the amount due listed on the healthcare provider's unpaid bill; 
 wherein the step of automatically generating a message containing a confirmation that the healthcare provider's bill has been validated occurs when one of the standardized adjudicated claims data exceeds the predetermined scoring threshold. 
 
     
     
       17. The method of  claim 13 , wherein the patient's identity is identified by one or more of a name, a social security number, a date of birth, or a zip code. 
     
     
       18. The method of  claim 13 , further comprising displaying on the patient's mobile device a comparison of the amount of the healthcare provider's unpaid bill that the patient is required to pay as calculated by the healthcare provider and the amount of the healthcare provider's unpaid bill that the patient is required to pay as reported by the standardized adjudicated claims data. 
     
     
       19. The method of  claim 18 , further comprising displaying a selectable control to pick whether to pay the amount of the healthcare provider's unpaid bill as calculated by the healthcare provider or the amount of the healthcare provider's unpaid bill that the patient is required to pay as reported by standardized adjudicated claims data. 
     
     
       20. The method of  claim 13 , further comprising:
 responsive to none of the standardized adjudicated claims data matching the digital dataset, automatically generating a message containing an explanation that the healthcare provider's unpaid bill has not been validated by the standardized adjudicated claims data; and 
 transmitting the message to the patient, so that the patient has immediate access to up-to-date payment information.